Poster Number

282

Document Type

Poster

Publication Date

3-2016

Abstract

More than 90% of patients with Morbid Obesity (MO) have Non-Alcoholic Fatty Liver Disease, complicated by Non-Alcoholic Steatohepatitis (NASH) in 10-15% with progression to fibrosis-cirrhosis in approximately 15%. Liver biopsy is the gold standard, but several non-invasive tests have shown an ability to predict severe liver fibrosis and NASH. The noninvasive blood tests have not been tested in patients with MO.

Methods:

Sixteen liver biopsies from MO patients undergoing gastric bypass surgery were studied retrospectively, identified from those previously assigned in random sequence to one of 5 stages of fibrosis (0- no fibrosis to 4- cirrhosis, based on histologic assessment). Inclusion criteria after EMR review were diagnosis of MO (BMI ³ 40 kg/m2) and availability of data concerning sex, age, BMI, Diabetes status, platelet count, AST, ALT and albumin within 3 months preceding surgery; exclusion criteria were no other potential causes of liver pathology. Diagnosis of NASH was by pattern of pathology and association with a NASH score of ³4, based on content of fat (0-3), lobular inflammation (0-3) and balloon hepatocytes (0-2). Tissue sections were stained with Sirius red (SR), scanned as whole slide images from which 10-20 grid fields were randomly selected to measure collagen proportionate area (CPA) using Image J software. Noninvasive blood tests for significant fibrosis (stages ³ 2) included NAFLD fibrosis, BARD, APRI and Fib4 scores, based on combinations of age, BMI, Diabetes, AST, ALT, platelets and albumin.

Results:

Sixteen liver biopsies from patients with MO met the study criteria, 11 had fatty liver. Patients were on average 50.3 yrs, BMI 47.5 and 56% female. Quantitation of fibrosis by SR image analysis showed significant fibrosis (stages ³ 2-4) in 7/16 biopsies (43.7%) and 6 of these had steatohepatitis (37.5%), all with significant fibrosis. There was poor correlation between the non-invasive test results and stage of liver fibrosis: NAFLD and BARD scores correctly assigned fibrosis scores in only 8/16 and 9/16 cases, respectively; APRI and Fib4 predicted 0 cases with stage 3-4 fibrosis. Elevations of AST and ALT were, however, strongly predictive of steatohepatitis: one or both were elevated in 6/7 with steatohepatitis, only one other case had minimally elevated ALT.

Conclusions:

Non-invasive markers for significant liver fibrosis (stage ³ 2) are not able to predict the stage of liver fibrosis in patients with MO; however, elevation of liver enzymes is strongly correlated with the presence of steatohepatitis.

Share

More than 90% of patients with Morbid Obesity (MO) have Non-Alcoholic Fatty Liver Disease, complicated by Non-Alcoholic Steatohepatitis (NASH) in 10-15% with progression to fibrosis-cirrhosis in approximately 15%. Liver biopsy is the gold standard, but several non-invasive tests have shown an ability to predict severe liver fibrosis and NASH. The noninvasive blood tests have not been tested in patients with MO.

Methods:

Sixteen liver biopsies from MO patients undergoing gastric bypass surgery were studied retrospectively, identified from those previously assigned in random sequence to one of 5 stages of fibrosis (0- no fibrosis to 4- cirrhosis, based on histologic assessment). Inclusion criteria after EMR review were diagnosis of MO (BMI ³ 40 kg/m2) and availability of data concerning sex, age, BMI, Diabetes status, platelet count, AST, ALT and albumin within 3 months preceding surgery; exclusion criteria were no other potential causes of liver pathology. Diagnosis of NASH was by pattern of pathology and association with a NASH score of ³4, based on content of fat (0-3), lobular inflammation (0-3) and balloon hepatocytes (0-2). Tissue sections were stained with Sirius red (SR), scanned as whole slide images from which 10-20 grid fields were randomly selected to measure collagen proportionate area (CPA) using Image J software. Noninvasive blood tests for significant fibrosis (stages ³ 2) included NAFLD fibrosis, BARD, APRI and Fib4 scores, based on combinations of age, BMI, Diabetes, AST, ALT, platelets and albumin.

Results:

Sixteen liver biopsies from patients with MO met the study criteria, 11 had fatty liver. Patients were on average 50.3 yrs, BMI 47.5 and 56% female. Quantitation of fibrosis by SR image analysis showed significant fibrosis (stages ³ 2-4) in 7/16 biopsies (43.7%) and 6 of these had steatohepatitis (37.5%), all with significant fibrosis. There was poor correlation between the non-invasive test results and stage of liver fibrosis: NAFLD and BARD scores correctly assigned fibrosis scores in only 8/16 and 9/16 cases, respectively; APRI and Fib4 predicted 0 cases with stage 3-4 fibrosis. Elevations of AST and ALT were, however, strongly predictive of steatohepatitis: one or both were elevated in 6/7 with steatohepatitis, only one other case had minimally elevated ALT.

Conclusions:

Non-invasive markers for significant liver fibrosis (stage ³ 2) are not able to predict the stage of liver fibrosis in patients with MO; however, elevation of liver enzymes is strongly correlated with the presence of steatohepatitis.